Healing Center

My guess is that there's never been a human being in the history of mankind who ever answered "Yes, sure, okay!" to the question "Would you like to pass another kidney stone?" We're not positive why some people get stones and others don't, but stone formation does run in families, and has less to do with diet than we once thought. When the stone, which forms in the kidney, decides to move, it's during the l-o-n-g passage down the ureter (the tube from the kidney to the bladder) that causes so much pain. If you ever start feeling a breathtakingly sharp colicky pain that seems to start in your back and spread toward your groin, get thee to an emergency room for fluids and pain control. Once it's passed (blessed relief!) come back and start reading our WholeHealthMD recommendations. The program we outline is excellent at prevention, and, if you've ever had a stone, it should especially interest you.

This chart indicates at a glance the herbal and nutritional supplements that I and other WholeHealthMD practitioners have found most helpful for this ailment. We've also provided specific dosages and other useful tips.

What are Kidney Stones?Kidney stones are one of the most common and painful disorders of the urinary tract. Also known as renal calculi, they form when minerals and crystallized salts in the urine concentrate and coalesce into hard, solid lumps in the urinary tract.Stones are typically characterized by their location in the urinary tract and by their composition. Urolithiasis is the term used to describe stones anywhere in the urinary tract; while nephrolithiasis refers to stones in the kidneys, ureterolithiasis to stones in the ureters (the tubes that drain urine from the kidneys to the bladder), and cystolithiasis to stones in the bladder. Stones that are large enough to occupy two or more of the calyces (urine collecting areas or horns) of the kidney are known as staghorn calculi.

The most common stones consist of calcium in combination with oxalate or phosphate. A less common type of stone is caused by an infection in the urinary tract and is known as an infection, or a struvite (ammonium magnesium phosphate) stone. These constitute 10-15% of all stones and occur more frequently in women with urinary tract infections. Other less common types of stones include uric acid stones and stones made of the amino acid cystine.

Kidney stones are usually yellow or brown, may be smooth or jagged, and vary in size from no larger than a grain of sand to as big as a golf ball. Larger ones may never leave the kidney and are detected only if an abdominal x-ray is taken for other reasons. Others are so small that they may pass through the entire urinary tract unnoticed.

If a stone is small enough to pass from the kidney into the ureter but too large to pass further on its own, the ureter tries to push it forward in a series of contractions that cause severe and excruciating pain known as renal colic. The pain will continue spasmodically until the stone reaches the bladder, a process that can take a few hours or as long as several days. Most of the time, a stone is passed without risks or complications. Sometimes, however, it can lodge in the ureter. In this situation, it may obstruct urine flow or and/or an infection can occur.

Traditionally, removing stones that were in the kidney or lodged in the ureter was a surgical procedure performed under general anesthesia. In recent years, new methods for removing stones use high-intensity ultrasound devices to break the stone into smaller pieces; this has dramatically changed the treatment of kidney stones.

Kidney stones may trouble as much as 10% of the American population at some time in their lives. They occur most often in men over age 40 and women over age 50. The incidence is higher among men than in women and among Caucasians than in African-Americans.

While heredity and persistent dehydration are known factors in the formation of kidney stones, the exact causes have not been determined. However, certain medical conditions may be linked to the type of stone that forms. Stones made of calcium may be caused by hypercalciuria (increased urinary calcium), an inherited condition in which excess calcium absorbed from food results in high levels of calcium in the urine. The excess calcium may cause crystals of calcium oxalate or calcium phosphate to form in the kidneys or urinary tract. Calcium-based antacids also increase calcium levels in the urine. Calcium oxalate stones may also form due to chronic bowel inflammation or to intestinal bypass or ostomy surgery, which shortens the course of food through the digestive tract. Excess oxalate in the urine may be the result of hyperoxaluria, a rare, inherited, metabolic disorder in which the body produces too much oxalate salt. Uric acid stones may be the result of hyperuricosuria, a disorder of uric acid metabolism or of gout, which also causes uric acid build-up in the joints. Cystinuria is a rare inherited metabolic disorder where the amino acid cystine builds up in the urine instead of dissolving normally. Cystinuria may lead to rare cystine stones. Other medical conditions linked to kidney stone formation include:

Urinary tract infections

Cystic kidney diseases

Hyperparathyroidism (excess production of parathyroid hormone that controls calcium absorption)

Surgery is not usually necessary to treat kidney stones. Once a kidney stone is diagnosed, most patients successfully pass stones through the urinary system by drinking 2-3 quarts of water per day and taking pain medication as needed. Doctors may ask patients to catch the stone in gauze or a sieve and save it for testing. It is important to know the type of stone in order to prescribe the appropriate treatment regimen to prevent stone recurrence. For example, medicine that helps prevent a calcium stone will not work for a struvite stone; diet changes that help prevent a uric acid stone may not prevent a calcium stone. (1-2)

Pain medications can help control the pain of passing the stone. For severe pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or narcotics may be prescribed. Doctors may also prescribe medications to decrease stone formation or to help break down the stone so the material can be excreted more easily. These medications may include:

Allopurinol (uric acid stones)

Antibiotics (struvite stones)

Thiazide Diuretics reduce the amount of calcium in the urine

Phosphate solutions (reduce the amount of calcium released into the blood)

Sodium bicarbonate or sodium citrate (both make the urine more basic) (3)

Initially, the doctor will obtain the patient's medical history and may ask about eating habits and occupation. Kidney stones that do not cause symptoms are sometimes discovered on x-rays taken during a general physical exam. If the patient has blood in the urine or sudden pain, an ultrasound may be performed to diagnose the location and size of the stone. Blood and urine tests may help detect substances that could promote stone formation. The entire urinary system might be visualized using a computerized tomography (CT) scan or an intravenous pyelogram (IVP).

If a stone has passed or been removed, the doctor may ask the patient to collect urine for another 24 hours to be sure there are no more and to assess the content of the urine for substances that lead to stone formation. The patient refrigerates the urine until it goes to the laboratory for testing to measure urine volumes and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinineâ€”a product of muscle metabolism used to measure kidney function. This information can help determine the cause of the stone. A second 24-hour collection may be required to determine if the prescribed treatment is working.

Causes constant pain and doesn't pass after a reasonable period of time

Is too large to pass on its own or is caught in a difficult place

Blocks urine flow

Causes an ongoing urinary tract infection

Causes constant bleeding or damages kidney tissue

Indicates it has grown as seen on follow-up x-rays

In the past, surgery for the removal of kidney stones was an open procedure requiring four to six weeks of recovery time. Today's treatment has improved and most procedures can be done on an outpatient basis. The three common procedures are:

Extracorporeal Shock Wave Lithotripsy (ESWL). This is the most frequently done procedure. Shock waves created outside the body travel through skin and tissue until they hit the dense stones. The stones break into small particles that are easily passed through the urinary system. The procedure requires anesthesia and may be performed on an outpatient basis with a recovery period of a few days.

Percutaneous Nephrolithotomy (PNL). This procedure is used when a stone is very large or in a location where ESWL cannot be used effectively. The surgeon makes a tiny incision in the back creating a tunnel directly into the kidney. With an instrument called a nephroscope, the surgeon locates and removes the stone. Patients usually stay in the hospital for several days and recovery time is longer than with ESWL. One advantage of this procedure is that the surgeon can remove some of the stone fragments instead of waiting on natural passage from the kidney.

Ureterorenoscopy (URS) may be utilized to visualize and grasp stones for direct removal through the ureter and bladder. This procedure does not require an incision. The surgeon passes a small fiber optic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon locates the stone and grasps it, or, if too large, may shatter it with an instrument that produces a form of shock wave. Sometimes a small tube or stent may be left in the ureter for a few days to help keep it open to maintain urine flow in case of swelling. (1)

To help prevent a recurrence, dietary measures may help, and vitamin and mineral supplements also have an important role to play.

Just a reminder: Anyone with a serious medical condition should talk to a doctor before beginning a new supplement regimen.

Preliminary studies in animals have shown that asparagus root inhibits kidney stone formation. However, research is limited. Studies in humans are needed. (4-5)

Traditionally, most doctors recommended restricting calcium intake for anyone prone to stones composed of calcium. But there is evidence that increasing calcium via supplements--for example, by taking calcium citrate--reduces stone formation by binding oxalate in the intestine so that it's not absorbed into the urine. (6)

Cranberry, taken as juice or in capsules, may help prevent both oxalate and uric acid stones from forming. In a 2003 small study, 20 men with no history of kidney stones consumed either 30% cranberry juice or tap water daily for two weeks. After a two-week washout period, the two groups crossed over for two more weeks. Cranberry juice consumption significantly altered three urinary risk factors for kidney stone production: oxalate and phosphate excretion decreased, calcium oxalate concentration decreased, and citrate excretion increased. (7)

Studies are conflicting concerning the use of the herb Equisetum arvense, commonly known as horsetail, for kidney stones. The German Commission E monographs approve its use for inflammation of the lower urinary tract and renal gravel; however there are few studies. (16) A 1994 review found that these benefits are mild and less effective than more well-known and well-studied substances. A 1999 study found horsetail supplementation did not increase urine output. (8-9)

Omega-3 fatty acids may benefit urinary calcium and oxalate excretion. In one small study, 15 healthy individuals consumed 900 mg eicosapentaenoic acid (EPA) and 600 mg docosahexaenoic acid (DHA) daily for thirty days in one segment of the study. The results indicated omega-3 supplementation decreased urinary oxalate excretion and the risk of calcium oxalate crystallization. However, larger studies are needed to confirm these findings. (10)

Uva ursi has a long history of use by alternative practitioners for treating kidney stones. Preliminary animal studies indicate some efficacy of Uva ursi in dissolving crystallized salts of kidney stones. More research is needed to confirm or refute efficacy in humans. (8, 11)

Vitamin A in higher than normal doses is used during the week or so after the passage of a stone to help heal the mucous membrane lining of the ureter. After about a week, reducing the dose of vitamin A to a maintenance level helps discourage stone formation. However, try to increase overall consumption of vitamin A-rich foods instead, including apricots, cantaloupe, carrots, sweet potatoes, and squash. In animal studies, vitamin A supplements of 20 times the normal amount restored the filtration rate of the kidneys, increased urinary pH, and increased excretion of citric acid. (12)

Vitamin B6 and magnesium are key nutrients for preventing the formation of calcium stones, by far the most common kind. Magnesium reduces calcium absorption and lowers urinary oxalate. B6 works well with magnesium. Stone formation is associated with a deficiency of both these nutrients. Magnesium also makes it easier for the body to dissolve calcium oxalate (one form of calcium found in stones). (13-14)

Drink plenty of water. To help prevent recurrences, drink at least three quarts of water per day--more in hot, humid weather. If the urine is not virtually colorless, more water should be consumed.

Reduce foods high in oxalate. Eat a healthy, balanced diet, but take it easy on asparagus, beets, beet greens, spinach, nuts, rhubarb, chocolate, and cola beverages.

Eat less meat. Anyone who is a heavy meat eater should try to reduce overall intake of animal protein. It encourages the body to excrete calcium, phosphorus, and uric acid in the kidneys. Actually, the very best diet to prevent kidney stones is a basically vegetarian one; high in a variety of fresh fruits, vegetables, and whole grains, and void of animal protein and processed foods, with plenty of fresh water, juices, and herbal teas.

Increase potassium intake. Foods that contain potassium include bananas, orange juice, fresh fruit and vegetables. Dandelion supplements are also a rich source. Low blood levels of potassium reduce levels of urinary citrate, which in turn raises levels of urine calcium. Like zinc, potassium is a potent inhibitor of calcium crystallization.

Get more magnesium in the diet. Many vegetables, grains, and fruits contain magnesium, including almonds, peanuts, brown rice, avocado, papaya, and prunes.

If the stone is found to be uric acid, avoid organ meats, sardines, anchovies, and brewer's yeast. All of these are high in purines, which can elevate uric acid in the blood and contribute to this type of stone formation.

Vibrationmassage therapy may enhance ESWL surgery. In one study of 103 patients with kidney stones, the group that received vibration massage in conjunction with ESWL had higher stone-free rates and lower stone recurrence rates than the group that was treated with ESWL only. ESWL combined with vibration massage appears to benefit the passage of kidney stones. (15)

Homeopathytreats individual patients according to the Principle of Similars; paying particular attention to what is unique about the patient's collection of symptoms rather than using one-size-fits-all medicine combinations for the condition. While there are no published studies of individualized homeopathic treatment for kidney stones, numerous books describe success in individual cases. Some homeopathic medicines (remedies) to think of for kidney stones include: Calcarea carbonica both for treatment and prevention of calcium containing stones; Berberis vulgaris for left-sided renal colic; Lycopodium clavatum for right-sided renal colic, Colocynthis for severe cramp-like abdominal pain that is somewhat relieved by heat and by hard pressure (bending forward). See the WholeHealthMD article on homeopathy for more information and to find a practitioner.

Here are some supplement suggestions you might want to start if you've passed a stone and are a little nervous about the thought of passing another. The doses I've used here assume you're already on a good high-potency multiple vitamin, and a complex of the new "super antioxidants."

How to Take the Supplements

Acute phase: If you now, right now, think you are passing a stone for the first time, start drinking plenty of fluid and take any good painkiller you may have in your medicine cabinet. Then, begin the vitamin A (to start the healing process), cranberry (to reduce the risk of infection), and the wild yam (to relax the ureter); and head for an emergency room to verify your diagnosis. If you get admitted, your doctor may allow you to continue these supplements during your stay; keep asking your nurse for more cranberry juice. Once you've passed the stone, you can stop the wild yam, and a week later, reduce the vitamin A.

Maintenance: Once you learn the type of stone you have, you can begin the appropriate dietary changes, and for stone prevention add the maintenance supplements--flaxseed, calcium, magnesium, vitamin B6, and zinc/copper--on a long-term basis.

The supplement program here assumes that your stone is the garden variety calcium oxalate type. If your stone is the less common uric acid variety, see the dietary and supplement recommendations for gout.

Important:

We at WholeHealthMD strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you're taking medications. Key cautions are given in the listing below, but you need to see the WholeHealthMD Reference Library for a comprehensive discussion of each supplement's cautions and drug/nutrient interactions.

Women, men, those over 50, those with chronic illness, and vegetarians have special needs to consider when choosing a multivitamin. Review your special needs below.

Why Everyone should be Taking a Multivitamin

There's nothing like a sound, low-fat diet full of fruits, vegetables, and whole grains to supply the vitamins and minerals we need to stay healthy. Unfortunately, we don't always eat well. Add to that the possible harmful effects of stress, aging, lack of exercise, pollution and illness, and supplements become even more important. That's why so many experts now recommend that everyone take a daily multivitamin.

The Right Choice: See Our Multivitamin Chart

This chart outlines the key vitamins and minerals your multivitamin should supply and the main benefits of each nutrient. It also gives what's called the daily value (DV) - a new government standard that generally corresponds to the RDA. The DV satisfies minimum daily requirements and helps prevent a deficiency disease, such as scurvy (lack of vitamin C). The higher levels of vitamins and minerals found in many multivitamins may actually help prevent disease, delay its onset or even lessen the severity of certain ailments.

Good Reason to Take an extra-strength Formula

If you eat an optimal diet of low-fat foods, at least five servings of fruits and vegetables daily, and chicken, lean meat, or fish several times a week, you can probably get away with a once-daily formula. But even those who consume a fairly well rounded diet and yield to junk-food lapses only occasionally can benefit from an extra-strength formula. If your idea of lunch is a slice of pizza and a diet soda, look for a multivitamin in the upper ranges of our chart.

•Read the label carefully to see
what you're getting. Many "high-potency"
formulas provide only extra amounts of the less-expensive ingredients.

•Don't pay more for "timed-
released" or "related" products. They're not worth the extra cost.

• Check the serving size. You may need to swallow up to six extra-strength pills a day to get the amounts listed on the label.

•Don't double up on one-a-days You'll be getting too much of certain nutrients, and not enough of others. If you want an extra-strength formula, buy one.

• Avoid mega doses that greatly exceed the upper doses listed in our chart, especially with fat-soluble vitamins A, D, E, and K; the minerals iron and selenium; or when taking any supplements long term. Be sure to account for any vitamins and minerals you may also be taking as individual supplements or as part of an herbal formula.

Fights infections; maintains eye and skin health. May be supplied in part as beta-carotene, which may lower the risk of cancer and heart disease and boost immunity. Pregnant women should not take more than 5,000 IU of vitamin A daily, but higher doses of beta-carotene are safe.

Promotes healthy bones and teeth; may protect against cancer.Adults may be deficient even with the usual doses of 400IU in multivitamins. Those over 50 should get at least 1000 IU and those over 70 may need at least 2000 IU of Vitamin D3. Avoid daily doses exceeding 10,000 IU, which may be toxic.

400 IU

200-400 IU

may need an additional 1000IU above what is in the multivitamin. Get a Vit D blood test to determine your needs.

Prevents anemia in younger women. Men and postmenopausal women should opt for iron-free formulas. Vegetarians who avoid all animal products and women with heavy periods should get at least 18 mg a day. Don't exceed 65 mg daily.

May cure colds, relieve prostrate complaints, and slow macular degeneration. Vegetarians who avoid all animal products, including dairy and eggs, should aim to get 30 mg. Don't exceed 60 mg daily, which can be harmful.

15 mg

15 mg

15-30 mg

Special Needs

Women

of all ages need at least 1,200 mg of calcium daily, through supplements or diet, to slow bone loss. Most multivitamins don't supply this much: A separate calcium supplement is probably your best bet. Younger women, especially those with heavy menstrual periods, need plenty of iron (18 mg a day ). Those considering pregnancy should get extra folic acid and avoid high-dose vitamin A. Special "women's formulas" may contain expensive herbs you may not need.

Men

should avoid multivitamins containing iron: Iron build-up has been linked to heart disease. Be wary of "men's formulas that tout ingredients like saw palmetto for prostate complaints. Many of these high-profile "extras" are present in such small amounts that they provide little or no therapeutic benefit.

Over 50,

opt for iron-free formulas: Too much of the mineral can cause heart problems. Look for vitamins B6 and B12 in the higher ranges, because as people age, they often have trouble absorbing these nutrients. Older women and men can benefit from the bone-strengthening effects of extra calcium (1,200 mg a day) and vitamin D (400 to 600 IU a day).

Chronic Illness

can lead to poor eating habits or deplete nutrient stores. Extra-strength formulas are especially important if you suffer from a long-term digestive ailment or have liver or gallbladder problems. Consult your doctor before taking supplements.

Vegetarians

who avoid all animal foods, including dairy and egg products, need at least 100 mcg daily of vitamin B12. Zinc, iron and calcium are also very important minerals for strict vegetarians.

Disclaimer: All material provided in the WholeHealthMD website is provided for educational purposes only. Consult your physician regarding the applicability of any information provided in the WholeHealthMD website to your symptoms or medical condition.